Management of retained lens fragments after cataract surgery with and without pars plana vitrectomy

Purpose: To compare the clinical course of patients with retained lens particles after phacoemulsification who had early or late pars plana vitrectomy (PPV) and removal of retained lens fragments or who were managed medically. Settings: Private practice and University of Louisville, School of Medicine, Louisville, Kentucky, USA. Methods: This retrospective review comprised patients who had cataract fragments dislocated into the vitreous during attempted cataract extraction and intraocular lens implantation over an 8-year period. Patients were divided into 3 groups. The early surgery group was treated with PPV and removal of lens fragments within 1 week of cataract surgery. The late surgery group had PPV more than 2 weeks after cataract surgery. The medical therapy group was managed with topical and systemic medications alone. The visual acuity, degree of corneal edema, inflammation, and intraocular pressure (IOP) were measured. Postoperative follow-up was at 7, 14, and 30 days and 1 year. Results: The study evaluated 42 patients (12 early surgery, 15 late surgery, and 15 medical therapy). Demographic characteristics, visual acuity, and mean IOP values at presentation were similar between the 3 groups. Visual acuity was not statistically significantly different between groups at 30 days and 1 year. There was no statistically significant difference in IOP between groups throughout the study period. Conclusions: Retained lens fragments were managed conservatively with good visual results. Vitrectomy was effective in patients with retained lens fragments not responding to topical and oral medication. Results indicate that surgery can be successfully delayed in certain patients.